TMS therapy works by using a magnetic field to induce a small electrical current in a specific part of the brain, activating neurons in a region involved in mood regulation. That is the one-sentence version. What actually happens across a six-week course is more gradual and more mechanical than most people expect, from the calibration step on day one to the week the response usually starts showing up. This article walks through both: the mechanism itself, and the week-by-week experience of a full course.
What We Know
|
The mechanism, in plain terms
A TMS coil is essentially a specialized electromagnet. When it activates, it produces a brief, focused magnetic pulse that passes painlessly through the scalp and skull, since magnetic fields move through tissue with almost no resistance. That pulse induces a small electrical current in the neurons directly beneath the coil, in the left dorsolateral prefrontal cortex, a brain region consistently found to be underactive in people with depression. Repeated pulses, delivered in patterned bursts over the course of a session, are thought to strengthen and normalize activity in that circuit over time, similar to how repeated use strengthens a muscle.
Session 1: motor threshold calibration
Before any treatment begins, your provider finds your motor threshold, the minimum stimulation intensity needed to produce a visible twitch in your thumb when the coil is positioned over the area of your brain that controls hand movement. This number becomes the baseline for your personal treatment intensity at Village TMS, since brain sensitivity to magnetic stimulation varies meaningfully from person to person. Skipping this step, or using a generic intensity, is how under- or over-treatment happens.
What a single session feels like, start to finish
- You sit in a chair, similar to a dental chair, fully clothed and awake
- The coil is positioned against your scalp using measurements taken at your first visit
- Pulses are delivered in patterned bursts, producing a tapping sensation and an audible clicking sound, which is why hearing protection is standard
- A session runs 20 to 40 minutes depending on the specific protocol used
- You can typically drive yourself home and return to normal activities immediately afterward
Week by week: what actually changes over a course
Week 1
This is when side effects, if any, are most noticeable, typically mild scalp discomfort or headache. Most patients do not notice a mood change yet, which is normal and not a sign that treatment isn’t working.
Weeks 2 to 3
Side effects generally ease as the scalp adjusts to repeated stimulation. Some patients begin noticing subtle shifts, such as slightly improved sleep or energy, though a clear mood change is still uncommon at this stage.
Weeks 3 to 5
This is the window where therapeutic response most often emerges in real-world data. Patients frequently describe it as gradual rather than sudden, a slow return of energy, motivation, or interest rather than a single dramatic turning point.
Week 6 and taper
Many protocols include a short taper phase, spacing sessions out rather than stopping abruptly, followed by a reassessment of symptoms to determine whether the acute course achieved response or remission and what comes next.
What happens after the acute course
For patients who respond, some providers offer periodic maintenance sessions to help sustain the improvement, since depression can recur even after successful treatment. For patients who do not reach full response by week six, options include extending the course, adjusting the stimulation protocol, or combining TMS with psychotherapy or, in some cases, a different treatment path such as Spravato.
Call 646-817-2835 or contact us to book a free consultation.
